As the 2016 Annual Enrollment Period approaches, one thing is clear: investors are already banking on Clover Health having a successful selling season. Clover Health, based in San Francisco, is a digital health insurance startup offering a Medicare Advantage government-subsidized plan in nine counties throughout New Jersey. Formerly known as CarePoint Health Plan, the…

Due to the combination of little to no inflation in 2015 and the Social Security “hold harmless” provision, annual standard Part B premiums are projected to increase by more than $650 in 2016 for millions of Americans that choose to receive Medicare Part B benefits. So, will your clients be part of the group paying as…

UnitedHealth Group’s pharmacy benefit management (PBM) company, OptumRx, recently partnered with fellow servicer Catamaran to create a new offering in pharmacy care, continuing a trend of consolidation. A PBM processes prescriptions for the groups that pay for drug, usually insurance companies or corporations, and use their size to negotiate with drug makers and pharmacies. According…

Beginning January 1, 2017, CMS will begin testing value-based insurance design (VBID) models to encourage using “high-value” clinical services to improve quality and reduce costs. “High-value” services are those that have the best chance to positively impact enrollee health. For five years, the model will be tested in Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania, and…

The Centers for Medicare & Medicaid Services (CMS) is imposing intermediate sanctions on Torchmark Corporation and its carriers First United Life Insurance and United American Insurance Company. Due to several noncompliance issues, CMS has placed a suspension on Torchmark’s enrollment of beneficiaries and marketing to beneficiaries for Prescription Drug Plan Contract Numbers S5580 and S5755….

Many consumers choose to get coverage through PPO plans because they allow more freedom for picking doctors or hospitals. But approximately 367,000 Texans will see that disappear next year when BlueCross BlueShield of Texas (BCBS-TX) drops their Blue Choice PPO plan. Check out the full story here or read my summary and thoughts on the matter below: In…

UnitedHealth Group reported its second quarter results on July 16, 2015. You can view the full report here on Business Wire’s website. For your quick-reading, I’ve highlighted some of the results below: Overall, UnitedHealth Group experienced strong, steady growth in the second quarter. Its revenues surpassed $36 billion, an increase of 11 percent year-over-year. Additionally, the revenues of…

Covered California has lost its standing as the top state for exchange enrollment, dropping behind Florida, according to new federal figures. The state signed up 1.36 million by the end of March, while Florida’s exchange had 1.42 million sign up, pick a plan and pay premiums. A California health advocate said comparing the two…